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THERE'S BEEN A LOT OF TALK ABOUT VACCINES FOR CHILDREN CAUSING MORE HARM THAN GOOD. SOME PARENTS ARE EVEN GOING AGAINST KNOWN PUBLIC GUIDELINES AND NOT VACCINATING THEIR CHILDREN FOR CERTAIN DISEASES.OURMore >>
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According to the American Academy of Pediatrics, about 18 percent of pediatricians admit to sometimes turning a parent away if they refuse to have their child immunized.
Patients and parents aren't only fired or terminated over differing opinions regarding childhood vaccines, however -- it can also involve disagreements over medical issues across the board.
If you refuse or demand a certain medical treatment or disagree with your doctor, you may be handed walking papers instead of a prescription.
According to the North Carolina Medical Board, patient termination is a growing issue and is primarily motivated by people feeling more empowered over their personal medical care.
Dr. Scott Kirby is the director of the North Carolina Medical Board.
Patients have the right to challenge medical providers in an effort to seek the best care possible, but Kirby warned, "There are physicians who feel that the patient has to accept the consequences to their conscientious objection to whatever recommendations the physician may make."
Those consequences should be clearly outlined in a doctor's written policies.
Whether it's over a treatment plan or a prescription, if patients and physicians don't see eye-to-eye, the physician may make an ethical or professional decision to "divorce" the patient from the doctor's practice.
A doctor could also take such action against an aggressive patient seeking a prescription drug they don't really need, or if the patient refuses to pay their bill or repeatedly misses their scheduled appointments.
According to the American Medical Association Guidelines, however, doctors should give sufficient notice to the patient to find another doctor.
In general, physicians must document the reason for the termination, and they should ensure the patient's medical records are appropriately transferred to another medical provider.
The physician should never just tell a patient to take a hike.
Cherie Minette is a naturopathic physician and she had concerns over whether or not to vaccinate her little boy.
When she discussed these concerns with her physician, Minette says, "She folded her arms and said, ‘If you can't trust us, we can't help you,' and I thought, you're right, you can't help me, but it shook me as a new mother."
Minette said she then wondered what she would do next, and if other doctors might react in a similar manner if she also voiced these same concerns to them.
"It's been said over and over, vaccines are a victim of their own success and people just don't understand how devastating these illnesses can be," Kirby pointed out.
Experts say the best defense against a doctor/patient "break-up" is for both to understand each other by thoroughly addressing all questions and concerns.
"If pediatricians don't take that time and opportunity to explain to parents the importance of vaccinations, or even just the other side of it, then they risk losing that parent and maybe that child to getting the care they need," Minette said.
Whether it's over vaccines or any other medical treatment, more terminated patients are now turning to naturopathic doctors like Minette for care.
An alternative to the traditional medical model, naturopathic doctors utilize natural therapies, diet and exercise to treat everything from allergies to heart disease for both individuals and families.
Naturopathic doctors, however, do not perform major surgery, and not all states legally license them to practice medicine.
Minette says naturopathic medicine is not a substitute for routine physicals or surgery, and patients need to communicate their homeopathic care to their physician to avoid any complications.
Regardless of whether you chose a medical or naturopathic physician, the doctor/patient relationship should be a partnership.
If there is ever a disagreement between you and your physician regarding your medical care, experts say the best prescription may be better communication.
The American Academy of Pediatrics strongly endorses universal immunization. Click to read more.
The role of the physician in these situations is to provideparents with the risk and benefit information necessary to makean informed decision and to attempt to correct any misinformationor misperceptions that may exist.
Parents who choose not to immunize theirown children increase the potential for harm to other personsin 4 important ways: (Source: http://aappolicy.aappublications.org/cgi/content/full/pediatrics;115/5/1428) a.) That child poses a potential threat to other unimmunizedchildren. b.) Even in a fully immunized population, a smallpercentage of immunized individuals will either remain or becomesusceptible to disease. c.) Some children cannot be immunized becauseof underlying medical conditions. These individuals derive importantbenefit from herd immunity and may be harmed by contractingdisease from those who remain unimmunized. d.) Immunizedindividuals are harmed by the cost of medical care for thosewho choose not to immunize their children and whose childrenthen contract vaccine-preventable disease.
Physicians should also explore the possibility that cost isa reason for refusing immunization. In such cases, the physicianshould work with the family to help them obtain appropriateimmunizations for the child.
Continued refusal after adequate discussion should be respectedunless the child is put at significant risk of serious harm(as, for example, might be the case during an epidemic).
Physician concernsabout liability should be addressed by good documentation ofthe discussion of the benefits of immunization and the risksassociated with remaining unimmunized. Physicians also may wishto consider having the parents sign a refusal waiver.
In general, pediatricians should avoid discharging patientsfrom their practices solely because a parent refuses to immunizehis or her child. However, when a substantial level of distrustdevelops, significant differences in the philosophy of careemerge, or poor quality of communication persists, the pediatricianmay encourage the family to find another physician or practice.Although pediatricians have the option of terminating the physician-patientrelationship, they cannot do so without giving sufficient advancenotice to the patient or custodial parent or legal guardianto permit another health care professional to be secured. <http://aappolicy.aappublications.org/cgi/content/full/pediatrics;115/5/1428>Such decisions should be unusual and generally made only afterattempts have been made to work with the family. Families withdoubts about immunization should still have access to good medicalcare, and maintaining the relationship in the face of disagreementconveys respect and at the same time allows the child accessto medical care. Furthermore, a continuing relationship allowsadditional opportunity to discuss the issue of immunizationover time.
Chronically abusive, disruptive or drug-seeking patients may be asked to leave.
Habitually missing appointments, refusing to pay reasonable bills, failing to heed medical advice.
Some pediatricians refuse care for children whose parents won't let them be vaccinated due to autism concerns.
A 2006 survey by the American Academy of Pediatrics found that 74% of members who participated had one or more parents refuse at least one vaccination in the past year; 32% of those parents changed their minds after education efforts from the doctor. Only about 16% of pediatricians said they sometimes discharge families if the parents won't relent.
Most doctors just agree to disagree.
Doctors can close practice to new patients, refuse to accept some insurance plans or limit Medicare or Medicaid patients but they cannot discriminate on race, gender, age or religion.
American Medical Association guidelines state that a doctor may withdraw from a case only after giving the patient enough notice to find another physician. State rules vary, but doctors generally must document the behavior, inform the patient what the problem is, give him or her a chance to change, then send a certified letter stating the relationship is over, while still agreeing to provide treatment as needed for another 30 days.
The right of doctors to refuse to treat some patients was upheld by the Fifth Circuit Court of Appeals in the 1987 case, Brown vs. Bower.
Despite adamant statements from the American Academy of Pediatrics and the U.S. Centers of Disease Control that vaccines have no link to autism, an anti-vaccination movement is growing online, from parent to parent. Click here to read more.
Some parents find help with a naturopath (a person who studied holistic medicine), but they do not have a legal license to practice medicine in most states.
The following notes are from Dr. Scott Kirby, director of the North Carolina Medical Board:
The term "fired" implies an employee/employer relationship. Kirby says a more appropriate term to describe the separation of a doctor and patient is "termination".
Physicians have a responsibility to individual patients, to other patients (i.e. in the waiting room), and to society at-large. They have to make decisions based on all three.
Fear of termination often causes patients to not tell their doctor about other treatments. In the end, that doesn't help anyone.
State medical boards issue position statements to their physicians giving guidelines on how to handle this situation.